Lévi-Strauss Julie, Benghanem Sarah, Hermann Bertrand, Bouchereau Eléonore, Legouy Camille, Sharshar Tarek, Gavaret Martine, Pruvost-Robieux Estelle
Université Paris Cité, Paris, France.
Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Paris, France.
Crit Care Med. 2025 Sep 1;53(9):e1736-e1747. doi: 10.1097/CCM.0000000000006766. Epub 2025 Jul 10.
This study aimed to evaluate the added prognostic value of late auditory evoked potentials (AEPs): mismatch negativity (MMN) and P3, alongside other prognostic markers (electroencephalogram, somatosensory evoked potentials, absent pupillary reflex), in the prognostication of patients with disorders of consciousness. We stratified our analysis based on the type of brain injury: hypoxic-ischemic brain injury (HIBI) vs. non-HIBI.
We performed a single-center retrospective study comparing the prognostic values of late AEPs and other neurophysiologic markers in predicting unfavorable outcomes, defined as a Glasgow Outcome Scale-Extended of 1-2 at 3 months, in both HIBI and non-HIBI groups. We compared the prognostic performance of a model including late AEPs to a model including only well-established markers.
We included 148 patients from one institution at the subacute phase after coma onset (median, 20.0 d). The main cause of disorder of consciousness was HIBI in 43.9% of cases, followed by stroke in 31.8%.
None.
The absence of P3 and MMN responses had a positive predictive value (PPV) for unfavorable outcome of 92.9% and 88.4% in HIBI, and 67.9% and 57.4% in non-HIBI, respectively. Predictive values of neurophysiologic markers were generally lower in non-HIBI compared with HIBI patients. Specifically, the PPV for unfavorable outcome of electroencephalogram malignant patterns and absent reactivity was significantly higher in HIBI compared with non-HIBI patients (76.9% vs. 31.3%, and 88.9% vs. 33.3%; p = 0.04, respectively). A model including AEPs significantly reduced the differences between individual predicted probabilities and actual outcome, both in the HIBI and non-HIBI contexts.
Integrating late AEPs into multimodal assessments enhances the model's predictive performance. Their contribution to neuroprognostication may be particularly relevant in the non-HIBI context, where the predictive values of neurophysiologic tools are lower than in the HIBI context. Late AEPs are interesting and cost-effective tools for neuroprognostication in both HIBI and non-HIBI contexts.
本研究旨在评估晚期听觉诱发电位（AEP）：失配负波（MMN）和P3，以及其他预后标志物（脑电图、体感诱发电位、瞳孔反射消失）在意识障碍患者预后评估中的附加预后价值。我们根据脑损伤类型进行分层分析：缺氧缺血性脑损伤（HIBI）与非HIBI。
我们进行了一项单中心回顾性研究，比较晚期AEP和其他神经生理标志物在预测不良结局方面的预后价值，不良结局定义为3个月时格拉斯哥扩展预后量表评分为1 - 2分，研究对象包括HIBI组和非HIBI组。我们将包含晚期AEP的模型的预后性能与仅包含成熟标志物的模型进行了比较。
我们纳入了一家机构的148例昏迷发作后亚急性期患者（中位时间为20.0天）。意识障碍的主要原因在43.9%的病例中是HIBI，其次是中风，占31.8%。
无。
P3和MMN反应缺失对HIBI组不良结局的阳性预测值（PPV）分别为92.9%和88.4%，对非HIBI组分别为67.9%和57.4%。与HIBI患者相比，非HIBI患者中神经生理标志物的预测价值普遍较低。具体而言，HIBI患者脑电图恶性模式和反应性消失对不良结局的PPV显著高于非HIBI患者（分别为76.9%对31.3%，88.9%对33.3%；p = 0.04）。在HIBI和非HIBI两种情况下，包含AEP的模型均显著降低了个体预测概率与实际结局之间的差异。
将晚期AEP纳入多模态评估可提高模型的预测性能。它们在神经预后评估中的作用可能在非HIBI情况下尤为重要，因为在这种情况下神经生理工具的预测价值低于HIBI情况。晚期AEP在HIBI和非HIBI情况下都是用于神经预后评估的有趣且具有成本效益的工具。
